SB838 SD2

SECTION 1. The legislature finds that over two hundred thousand residents live in rural areas in the State, where unique challenges in health care access, affordability, and outcomes are prevalent. Rural residents in the State often face a higher risk of chronic health issues, including higher rates of diabetes and associated complications. According to the federal Centers for Disease Control and Prevention, rural residents are more likely to experience premature mortality from heart disease, cancer, unintentional injuries, chronic lower respiratory disease, and stroke.

The legislature further finds that, despite these obstacles, rural residents in the State play an essential role in the State's economy, particularly in food and energy production. However, managing diabetes within these communities remains particularly challenging, with patients often facing limited access to health care resources and critical diabetes management tools. Approximately 108,600 adults, or 9.5 per cent of the adult population in the State live with diabetes, requiring strict management of blood glucose levels, medication, and lifestyle choices to prevent serious complications.

The legislature also finds that continuous glucose monitors (CGMs) offer life-changing benefits by providing real-time data and trends on blood glucose levels, which surpass the limited information from traditional blood glucose meters. CGMs help patients avoid dangerous blood sugar fluctuations and reduce long-term complications, including the need for emergency care. Studies show that individuals with diabetes using CGMs experience fewer hypoglycemic episodes and lower A1C levels, improving overall health outcomes.

Given these benefits, the legislature finds that it is in the State's best interest to expand access to continuous glucose monitoring technology, particularly for residents in rural and high-risk communities. By doing so, the State aims to reduce health disparities, increase health equity, and lower overall health care costs.

Accordingly, the purpose of this Act is to require all health insurers in the State, excluding medicaid managed care programs, to cover the cost of continuous glucose monitors and related supplies in their policies under certain conditions.

SECTION 2. Section 431:10A-121, Hawaii Revised Statutes, is amended to read as follows:

"§431:10A-121 Coverage for diabetes. [~~Each~~] (a) Except as provided in subsection (b), each policy of accident and health or sickness insurance providing coverage for health care, other than an accident-only, specified disease, hospital indemnity, medicare supplement, long-term care, or other limited benefit health insurance policy, that is issued or renewed in [~~this~~] the State, shall provide coverage for outpatient diabetes self-management training, education, equipment, and supplies, if:

(1) The equipment, supplies, training, and education are medically necessary; and

(2) The equipment, supplies, training, and education are prescribed by a health care professional authorized to prescribe.

(b) Each individual or group accident and health or sickness insurance policy issued or renewed in the State after December 31, 2025, shall provide coverage for the cost of continuous glucose monitors and related supplies for individuals covered under the policy and diagnosed with diabetes, including gestational diabetes, regardless of whether they are treated with insulin; provided that:

(1) The continuous glucose monitors are medically necessary and prescribed by a health care professional authorized to prescribe the device; and

(2) The coverage:

(A) Shall include the cost of any necessary repairs or replacement parts for the continuous glucose monitor;

(B) Shall be subject to a minimum benefit of $ every months; and

(C) May be subject to copayment, deductible, and coinsurance provisions of the policy, contract, plan, or agreement that are no less favorable than the copayment, deductible, and coinsurance provisions for other medical services, equipment, or supplies covered by the policy;

provided further that this subsection shall not apply to limited benefit health insurance as provided in section 43l:10A—607.

For the purposes of this subsection, "continuous glucose monitor" means a device designed to aid in diabetes management by continuously measuring glucose levels through a small electronic sensor applied to the skin that remains in place for a minimum of seven days, transmitting glucose data in real-time or at set intervals to monitor and maintain safe blood glucose levels."

SECTION 3. Section 432:1-612, Hawaii Revised Statutes, is amended to read as follows:

"[[]§432:1-612[]] Diabetes coverage. [~~All~~] (a) Except as provided in subsection (b), all group health care contracts under this chapter shall provide, to the extent provided under section 431:10A-121, coverage for outpatient diabetes self‑management training, education, equipment, and supplies.

(b) Each individual or group hospital or medical service plan contract issued or renewed in the State after December 31, 2025, shall provide coverage for the cost of continuous glucose monitors and related supplies to the extent provided under section 431:10A-121.

For the purposes of this subsection, "continuous glucose monitor" has the same meaning as defined in section 431:10A‑121."

SECTION 4. The benefit to be provided by health maintenance organizations corresponding to the benefit provided under section 431:10A-121, Hawaii Revised Statutes, as amended in section 2 of this Act, as contained in section 432D-23, Hawaii Revised Statutes, shall take effect for all policies, contracts, plans, or agreements issued or renewed in the State after December 31, 2025.

SECTION 5. The department of health may accept and expend funds from gifts, grants, and donations from individuals, private organizations, foundations, or other governmental agencies to support the expansion of continuous glucose monitor access; provided that no gift, grant, or donation may be accepted if subject to conditions inconsistent with the laws of this State.

SECTION 6. Section 23-51, Hawaii Revised Statutes, shall not apply to this Act.

SECTION 7. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 8. This Act shall take effect on July 1, 2050; provided that sections 2, 3, and 4 shall apply to all policies, contracts, plans, or agreements issued or renewed in the State after December 31, 2025.

THE SENATE	S.B. NO.	838
THIRTY-THIRD LEGISLATURE, 2025		S.D. 2
STATE OF HAWAII